儿童实体瘤合并侵袭性真菌感染3例临床分析

Clinical analysis of 3 cases of invasive fungal infection in children with solid tumors

目的总结实体瘤患儿合并侵袭性真菌感染的诊断与治疗经验。方法回顾性分析3例实体瘤患儿于化疗过程中合并侵袭性真菌感染的临床特点及诊治经过。结果 3例实体瘤患儿均于多疗程化疗后发生肺部真菌感染,其中1例合并其他部位感染。3例患儿均有发热、中性粒细胞缺乏,曾使用广谱抗生素、激素治疗。3例患儿血真菌培养均为阳性,其中近平滑假丝酵母菌2例,白色念珠菌1例,1-3-β-D葡聚糖检测结果明显升高。3例患儿肺部CT均表现为密度增高、渗出炎症阴影。2例患儿治疗后好转存活,1例经治疗好转后,因肿瘤多发转移而死亡。结论肺部真菌感染为儿童实体瘤合并侵袭性真菌感染的常见表现形式,多发生于多次化疗后骨髓抑制期;临床表现缺乏特异性,需结合病史、实验室及影像学检查作出诊断;可疑侵袭性真菌感染时应及时进行经验性治疗。[临床儿科杂志,2012,30(5):425-427]

Objective To summarize the experience of diagnosis and treatment of invasive fungal infections in children with solid tumors.Methods Retrospectively reviewed the clinical manifestations,diagnosis and treatment of invasive fungal infection in three children with solid tumors during chemotherapy.Results Three children with solid tumors were infected with fungus in the lung after multi-course chemotherapy and one of them combined with other sites infections.They all had fever and neutrophil deficiency,treated ever with broad-spectrum antibiotics.The blood fungal cultures of 3 patients were positive,2 patients were Candida parapsilosis,and 1 was Candida albicans with pretty high result of 1-3-β-D glycan test.Lung CT scans of 3 patients all showed higher density of the shadow of exudative inflammation.After treatment the condition of 2 patients had been improved and survived while another one deceased because of tumor metastasis.Conclusions Pulmonary fungal infection in childhood solid tumors were seen combined with invasive fungal infections,occurred in bone marrow suppression period after several chemotherapies.It lacks of specific clinical manifestations,so clinical history,laboratory exams and imaging are needed to make diagnosis.Empiric treatment should proceed when invasive fungal infection is suspected.